[1]宋　倩a,张　雯b.急性心肌梗死患者血浆PCSK9 水平对临床不良事件发生的预测价值分析[J].现代检验医学杂志,2020,35(03):72-77.[doi:10.3969/j.issn.1671-7414.2020.03.018]
　SONG Qiana,ZHANG Wenb.Analysis of the Predictive Value of Plasma PCSK9 Level on Clinical Adverse Events in Patients with Acute Myocardial Infarction[J].Journal of Modern Laboratory Medicine,2020,35(03):72-77.[doi:10.3969/j.issn.1671-7414.2020.03.018]
点击复制

急性心肌梗死患者血浆PCSK9 水平对临床不良事件发生的预测价值分析()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第35卷
期数:
2020年03期
页码:
72-77
栏目:
论著
出版日期:
2020-07-20

文章信息/Info

Title:
Analysis of the Predictive Value of Plasma PCSK9 Level on Clinical Adverse Events in Patients with Acute Myocardial Infarction
文章编号:
1671-7414（2020）03-072-06
作者:
宋　倩a; 张　雯b
（延安大学附属医院a. 检验科；b. 血液免疫科，陕西延安　716000）
Author(s):
SONG Qiana;  ZHANG Wenb
（a. Department of Clinical Laboratory;b. Department of Hematology and Immunology,Affiliated Hospital of Yan’an University, Shaanxi Yan’an 716000, China）
关键词:
急性心肌梗死; 前蛋白转化枯草杆菌蛋白酶9; 复合心血管不良事件; Cox 回归分析
分类号:
R542.22；R446.11
DOI:
10.3969/j.issn.1671-7414.2020.03.018
摘要:
目的　探讨急性心肌梗死（acute myocardial infarction, AMI）患者血浆前蛋白转化枯草杆菌蛋白酶9（PCSK9） 水平对临床不良事件发生的预测价值。方法　选取2017 年1 月~ 2018 年12 月在延安大学附属医院确诊的急性心肌梗 死患者271 例，平均年龄55.1±9.9 岁，其中男性172 例（63.47%），按出院后第1 月、3 月、6 月、12 月进行随访， 随访1 年，主要随访方式为电话随访和门诊随访，记录临床不良事件。共59 例发生临床不良事件（21.77%）。ROC 曲线结果显示：血浆PCSK9 诊断AMI 患者临床不良事件的最佳预测值为309.6ng/ml（（曲线下面积、敏感度和特异 度分别为0.773，0.779 和0.746），据此将研究对象分为PCSK9(L) 组（PCSK ＜ 309.6ng/ml）, 共163 例，平均年龄 55.1±9.4 岁，男性102 例 ；PCSK9(H) 组（PCSK ≥ 309.6ng/ml）, 共108 例，平均年龄54.9±10.6 岁，男性70 例。 比较PCSK9(H) 组和PCSK9(L) 组患者实验室指标血浆PCSK9、血清总胆固醇（TCHO）、三酰甘油（TG）、高密度 脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血糖（GLU）、年龄、性别、既往史（吸烟、饮酒、 糖尿病、高血压、高脂血症、冠心病）、入院时Killip 心功能分级、左心射血分数及临床不良事件发生率。Cox 回归 分析血浆PCSK9 水平对AMI 患者临床不良事件的预测价值。结果　PCSK9(H) 组和PCSK9(L) 组血浆PCSK9 水平为 386±70.31ng/ml vs 232±53.17ng/ml，差异有统计学意义（t=24.545，P=0.000），血清LDL-C 水平为2.71±0.62mmol/L vs 2.19±0.57mmol/L，差异有统计学意义（t=3.616，P=0.037）。PCSK9(H) 组和PCSK9(L) 组复合心血管不良事件发生 率为23.15% vs 11.66%，差异有统计学意义（χ2=6.308, P=0.012），心力衰竭发生率为13.89% vs 5.52%，差异有统计学 意义（χ2=5.634, P=0.018） 。经Log Rank 检验：PCSK9(H) 组和PCSK9(L) 组非复合心血管事件生存率组间差异有统计 学意义（χ2=12.735, P=0.007）。经多因素Cox 回归分析，血浆PCSK9 水平是AMI 患者复合心血管不良事件及心力衰 竭的独立危险因素（HR=1.507~1.517，95%CI:1.218~1.735, 均P ＜ 0.05）。结论　血浆PCSK9 水平是AMI 患者临床不 良心血管事件的独立危险因素。
Abstract:
Objective　To investigate the predictive value of proprotein convertase subtilisin kexin type9(PCSK9) level on clinical adverse events in patients with acute myocardial infarction(AMI). Methods　271 patients with acute myocardial infarction diagnosed in the Affiliated Hospital of Yan’an University from January 2017 to December 2018 were selected, with average age 55.1 ± 9.9 years and 172 cases (63.47%) of men. The patients were followed up for 1 year according to the first month, 3 months, 6 months and 12 months after discharge. The main follow-up methods were telephone follow-up and outpatient follow-up, and clinical adverse events were recorded, 59 cases had clinical adverse events (21.77%). ROC curve results showed that: The optimal predictive value of plasma PCSK9 for the diagnosis of clinical adverse events in AMI patients was 309.6ng/ml (area under the curve was 0.773, sensitivity was 0.779, and specificity was 0.746). Therefore, subjects were divided into PCSK9(L) group (PCSK< 309.6ng/ml, a total of 163 patients, average age 55.1±9.4 years, 102 males) and PCSK9(H) group (PCSK ≥ 309.6ng/ml, a total of 108 patients, average age 54.9±10.6 years, 70 males). The laboratory indexes (PCSK9, TCHO, TG, HDL-C, LDL-C, Glu), age, gender, past history (smoking, drinking, diabetes, hypertension, hyperlipidemia, coronary heart disease) and Killip heart function at admission were compared between PCSK9 (H) group and PCSK9 (L) group classification, left ventricular ejection fraction and incidence of clinical adverse events.Cox regression analysis was carried out to

参考文献/References:

[1]　 郑昕, 白雪珂, 王斌, 等. 中国中西部城市医院经皮 冠状动脉介入治疗十年趋势--China PEACE 回顾性 CathPCI 研究结果[J]. 中国循环杂志, 2016, 31（5）: 426-431. 　　 ZHENG Xin, BAI Xueke, WANG Bin, et al. Ten year trend of percutaneous coronary intervention in central western urban hospitals in China -- Results from China PEACE retrospective CathPCI study [J]. Chinese Circulation Journal , 2016, 31（5）: 426-431.
[2]　 LI Jing, LI Xi, WANG Qing, et al. ST-segment elevation myocardial infarction in China from 2001 to 2011 （the China PEACE-Retrospective Acute Myocardial Infarction Study）: a retrospective analysis of hospital data[J]. Lancet, 2015, 385（9966）: 441- 451.
[3]　 程俊杰, 李静, 梁西强, 等. 非高密度脂蛋白胆固醇 与冠心病患者心功能分级的相关性研究[J]. 现代检 验医学杂志,2016,31(3):43-47. 　　 CHENG Junjie, LI Jing, LIANG Xiqiang, et al. Correlation between non-high density lipoprotein cholesterol and cardiac function in patients with coronary heart disease [J]. Journal of Modern Laboratory Medicine, 2016,31(3):43-47.
[4]　 罗聪聪, 鲍春荣, 何斌. 前蛋白转化酶枯草溶菌素9 单克隆抗体治疗冠状动脉粥样硬化性心脏 病的临床研究进展[J]. 上海交通大学学报( 医学 版),2018,38(3):339-342. 　　 LUO Congcong, BAO Chunrong, HE Bin. Clinical advances in monoclonal antibody against pcsk9 for coronary atherosclerotic heart disease[J]. Journal of Shanghai Jiaotong University (Medical Science),2018, 38(3):339-342.
[5]　GENCER B, MONTECUCCO F, NANCHEN D, et al.Prognostic value of PCSK9 levels in patients with acute coronary syndromes[J]. Eur Heart J, 2016, 37(6):546-553.
[6]　LI Jianjun, LI Sha, ZHANG Yan, et al. Proprotein convertase subtilisin/ kexin type 9, C-reactive protein, coronary severity, and outcomes in patients with stable coronary artery disease:a prospective observational cohort study[J]. Medicine （Baltimore）, 2015, 94 （52）:e2426.
[7]　　MENDIS S，THYGESEN K, KUULASMAA K，et a1. World Health Organization difinition of myocardial infarction：2008-09revision[J]．Int J Epidemiol， 2011,40(11)：139-146．
[8]　　陈静, 王文尧, 王思远, 等. 甲状腺功能异常对急性 心肌梗死患者预后的影响[J]. 中国循环杂志,2019,34 （5）:461-466. 　　 CHEN Jing, WANG Wenyao, WANG Siyuan, et al. Prognositic value of thyroid dysfunction of patients with acute myocardial infarction [J]. Chinese Circulation Journal, 2019, 34（5） : 461-466.
[9]　　DUBUC G，TREMBLAY M，PARE G，et a1．A new method for measurement of total plasma PCSK9： clinical applications[J]．J Lipid Res，2010，51（1）： 140-149．
[10] LI Sha，ZHANG Yan，XU Ruixia，et al. Proprotein conver-tase subtilisin-kexin type 9 as a biomarker for the severity of coronary artery disease［J］. Ann Med，2015，47（5）：386- 393.
[11] SABATINE M S, GIUGLIANO R P．KEECH A C, et a1. Evolocumab and clinical outcomes in patients with cardiovascular disease[J]．N Engl J Med， 2017,376(18):1713-1722．
[12] RIDKER P M, REVKIN J, AMARENCO P, et al. Cardiovascular efficacy and safety of bococizumab in high-risk patients[J]. N Engl J Med, 2017, 376(16): 1527-1539.
[13] 张闻多, 张永勇, 于雪, 等. 急性心肌梗死患者血浆 前蛋白转化酶枯草溶菌素9 水平的动态变化及临床 意义[J]. 中国临床医生杂志,2018,46（8）: 895-898. 　　 ZHANG Wenduo, ZHANG Yongyong, YU Xue, et al. The changes and value of serum PCSK9 in patients with acute myocardial infarction [J]. Chinese Journal for Clinicians,2018,46（8）:895-898.
[14] 高岩，张海波，侯丽波，等. 未行再灌注治疗的急 性心肌梗死患者血浆PCSK9 水平对1 年内心血管 事件再发的预测价值[J]. 中华医学杂志，2019，99 （35）:2750-2755. 　　 GAO Yan, ZHANG Haibo, HOU Libo, et al. Predictive value of plasma PCSK9 level in acute myocardial infarction patients without reperfusion therapy for recurrence of cardiovascular events within 1 year [J]. Natl Med J China,2019,99（35）:2750-2755.

相似文献/References:

[1]达晶,张超,吴红葵,等.急性心肌梗死患者血浆miRNA-423-5p 与整合素连接激酶水平表达对评价近期临床预后的价值[J].现代检验医学杂志,2020,35(05):33.[doi:10.3969/j.issn.1671-7414.2020.05.009]
　DA Jing,ZHANG Chao,WU Hong-kui,et al.Expression of Plasma miRNA-423-5p and Integrin-linked Kinase Levels in Patients with Acute Myocardial Infarction for Evaluating Recent Clinical Outcomes[J].Journal of Modern Laboratory Medicine,2020,35(03):33.[doi:10.3969/j.issn.1671-7414.2020.05.009]
[2]刘　云,孙静芳,马　萍.外周血血细胞参数在急性主动脉夹层与急性心肌梗死鉴别中的价值[J].现代检验医学杂志,2021,36(01):132.[doi:10.3969/j.issn.1671-7414.2021.01.033]
　LIU Yun,SUN Jing-fang,MA Ping.Value of Peripheral Blood Cell Parameters in Differentiating Acute Aortic Dissection from Acutemyocardial Infarction[J].Journal of Modern Laboratory Medicine,2021,36(03):132.[doi:10.3969/j.issn.1671-7414.2021.01.033]
[3]李　娟,张芬红,徐卓婧,等.老年急性 ST 段抬高型心肌梗死患者血浆 miR-499-5p 表达水平对并发急性心力衰竭的预测价值[J].现代检验医学杂志,2021,36(03):48.[doi:10.3969/j.issn.1671-7414.2021.03.011]
　LI Juana,ZHANG Fen-honga,XU Zhuo-jinga,et al.Predictive Value of Plasma miR-499-5p for Acute Heart Failure afterAcute ST-Elevated Myocardial Infarction in Elderly Patients[J].Journal of Modern Laboratory Medicine,2021,36(03):48.[doi:10.3969/j.issn.1671-7414.2021.03.011]
[4]杜春娟,李　丹,王　岑,等.急性心肌梗死并发阿斯综合征患者血清和肽素与 Adropin 水平联合检测的早期诊断价值研究[J].现代检验医学杂志,2021,36(03):97.[doi:10.3969/j.issn.1671-7414.2021.03.022]
　DU Chun-juan,WANG Cen,HUYAN-Li,et al.Study on the Early Diagnostic Value of Serum Copeptin and Adropin Levels in Patients with Acute Myocardial Infarction Complicated with Adams-stokes Syndrome[J].Journal of Modern Laboratory Medicine,2021,36(03):97.[doi:10.3969/j.issn.1671-7414.2021.03.022]
[5]刘 蕾a,赵 鹏b,张 军a,等.急性心肌梗死患者血浆外泌体miR-21-3p/PTEN/AKT 表达水平及诊断价值研究[J].现代检验医学杂志,2022,37(05):118.[doi:10.3969/j.issn.1671-7414.2022.05.023]
　LIU Leia,ZHAO Pengb,ZHANG Juna,et al.Serum Exosomal miR-21-3p/PTEN/AKT Expression and Diagnostic Value in Patients with Acute Myocardial Infarction[J].Journal of Modern Laboratory Medicine,2022,37(03):118.[doi:10.3969/j.issn.1671-7414.2022.05.023]
[6]柴亮听,张 卉,冯 艳,等.急性心肌梗死患者血清miR-423-5P，Bcl-2 和LC3-II 水平表达与预后相关性研究[J].现代检验医学杂志,2023,38(01):117.[doi:10.3969/j.issn.1671-7414.2023.01.022]
　CHAI Liang-ting,ZHANG Hui,FENG Yan,et al.Correlation between Serum of miR-423-5p, Bcl-2 and LC3-II and Prognosis in Patients with Acute Myocardial Infarction[J].Journal of Modern Laboratory Medicine,2023,38(03):117.[doi:10.3969/j.issn.1671-7414.2023.01.022]
[7]雷荣浩,潘 婉,雷 杰.急性心肌梗死患者血清DHEA-S和VK2水平表达与心室重构的相关性研究[J].现代检验医学杂志,2024,39(06):157.[doi:10.3969/j.issn.1671-7414.2024.06.027]
　LEI Ronghao,PAN Wan,LEI Jie.Study of the Correlation between the Expression of Serum DHEA-S and VK2 Levels and Ventricular Remodeling in Patients with Acute Myocardial Infarction[J].Journal of Modern Laboratory Medicine,2024,39(03):157.[doi:10.3969/j.issn.1671-7414.2024.06.027]
[8]郝翠君a,王 蕊a,洪 洋a,等.急性心肌梗死患者PBMC中CSF2RB mRNA和GZMA mRNA表达水平与PCI术后心室重构的关系研究[J].现代检验医学杂志,2025,40(02):77.[doi:10.3969/j.issn.1671-7414.2025.02.014]
　HAO Cuijuna,WANG Ruia,HONG Yanga,et al.Relationship between CSF2RB mRNA and GZMA mRNA Expression Levels in PBMC of Patients with Acute Myocardial Infarction and Ventricular Remodeling after PCI[J].Journal of Modern Laboratory Medicine,2025,40(03):77.[doi:10.3969/j.issn.1671-7414.2025.02.014]

备注/Memo

备注/Memo:
收稿日期：2020-02-24 修回日期：2020-03-06作者简介：宋倩（1986-），女，本科，主管检验师，专业：分子生物学，E-mail：344618684@qq.com。 通讯作者：张雯（1988-），女，E-mail：329391168@qq.com。
更新日期/Last Update: 2020-07-20